Blood Services

Introduction and Background

Blood Transfusion Service of Nepal Red Cross Society was established in the year 1966 i.e. 3 years after the inception of the Society itself. During the initial years the service was available only for the people of Kathmandu but over the years blood banks have been established in 68 places of 48 districts of the country.

In the initial years the service was made possible through collection of blood from professional donors but since 1982 collection of blood was emphasized from voluntary non remunerated donors only. In the meanwhile serious efforts were made and are being made to collect blood from institutionalized sectors like colleges, universities, industries, clubs, governmental and non governmental offices. Today, blood is collected mostly from these sectors through routine motivational and collection campaigns but motivated individuals are also significant donors. The blood collection mobile teams routinely visit these institutions in the valley and in the outskirts of Kathmandu Valley to collect blood. Sometimes these teams also spread out to other adjoining districts for the purpose.

With the expansion of health services, establishments of medical colleges, government and private hospitals and Nursing homes the demand of blood is rapidly going up not only in the Valley but also in the districts.

Government of Nepal, in it's policy declaration of 1991, has mandated Nepal Red Cross Society as the sole authority in conducting blood programmes in Nepal. Therefore, a great responsibility has fallen on the Society and to prove its capability, it is systematically strengthening itself with resources available nationally and exploring resource possibilities internationally. The Kathmandu-based Central Blood transfusion service , so far being the only referral centre for the whole country, has been planning not only to upgrade the Centre but also in upgrading regional blood centres of Biratnagar, Pokhara, Nepalgunj and Chitwan. It is also considering the possibilities of upgrading the Dharan and Dhangadhi blood centers in view of the establishments there of major hospitals and coverage area. As it stands today, there are 21 district level blood banks, emergency units in 17 and 25 hospital units of the services in the country.

His Majesty’s Government of Nepal (HMG/N) mandated Nepal Red Cross Society on Chaitra 24, 2048 BS as a sole agency to organize comprehensive blood collection, storage and supply related services in Nepal. Subsequently, a national policy on blood transfusion related services was developed and approved by HMG/N through a Cabinet decision on Bhadra 10, 2050.

Through this policy, HMG/N reiterates its mandate and commits to provide required support to Nepal Red Cross for provision and timely supply of adequate and safe blood to meet clinical needs of all people of Nepal in an equitable and affordable manner in partnership with NRCS.

Central level: The Central Blood Transfusion Service Center (CBTSC) in Kathmandu is responsible for management of services in the Kathmandu valley, and for supervising and monitoring the technical standards of the district centers, providing guidance to ensure the collection and supply of safe blood. Thus, the CBTSC not only serves the blood transfusion needs of the people in Kathmandu valley, but also provides technical and other supports to the blood service centres across the country. In the year 2008 nationwide 1,78652 units of blood and blood products were provided to the patients from different blood centers.

Blood Transfusion Service Centers in Nepal

Types/Levels of BTCs

Number

Coverage

Central BTSC

1

Kathmandu

Regional BTSCs

4

Biratnagar, Pokhara, Nepalgunj, Chitwan

District BTSCs

21

Emergency BTCs

17

17 districts

Hospital units

25

In different hospitals and medical colleges

Note: Emergency BTSCs have no storage facilities, but keep a list of donors who can be called upon to donate blood in an emergency. They provide basic cross-matching and testing services.

Regional: Four of the five regions have blood transfusion service centers at Biratnagar, Pokhra, Nepalganj and Chitwan. Those provide local services, and thus there is no distinct functioning management structure at the regional level.

District: The district BTSCs are managed by NRCS district chapters. These centres are supposed to comply with guidelines provided under the 1983 NRCS regulations and the 1998 Standard Operating Procedures. However, some of them operate independently, each setting up independent systems and charges. They receive no government funding, but some support in procurement of supplies provided by the Central Blood Transfusion Service Centre

In spite of all the blood service centres operating in the country within the NRCS umbrella, the district centres are autonomously run in terms of day to management and provision of financial resources. Accordingly, in some districts, the local Red Cross Chapters and the hospitals have developed a collaboration mechanism to ensure that the patients get safe blood in the timely manner. However, a nationwide collaboration mechanism between different sectors, such as Ministry of Health, Nepal Red Cross, Hospitals (both in the public and private sector) is yet to be established.
Many international organizations are also monitoring the quality standards of the blood services in Nepal. Though NRCS provides safe blood to the various institutions in Nepal, there is a need to develop technical and other service standards in the blood services which are as per with the international standards, and apply them uniformly in all the Centres across the country. In order to do so, a partnership mechanism to share the knowledge, risks, and resources between Nepal government and Nepal Red Cross have to be developed and implemented. These issues have not been well elaborated in National Blood Policy 2050.

Therefore, a need of National Blood Policy that elaborates on the technical and service quality standards, management structures, partnership mechanisms and monitoring and evaluation systems that are required to provide safe blood in the timely manner was considered essential. These aspects are being included in the present updated National Blood Policy 2062.

Purpose

To ensure adequate, safe and timely supply of blood and blood products to meet the transfusion requirements of the people of Nepal in an equitable and affordable manner.

Objectives

To promote voluntary non-remunerated blood donors,

To strengthen capacity of BTS in phased manner through equipping them to collect and distribute safe blood

To update and standardise the methodologies for grouping and HIV, HBsAg, HCV, syphilis testing for the needy people

To improve quality through implementation of SOP

To strengthen institutional capacity at all level of BTS centres

Activities

Human Resources Development
Blood Transfusion service regularly organize different training programs to develop the skill and knowledge of staffs with its own resources and also with the support of national and international partners.

Donor motivation, IEC material development and Donor Recognition
Safe blood donation motivation program is running in different level. IEC materials
developed and distributed in the public to aware people on safe blood
donation information. With these materials people knows why we have to donate blood ,
how it will be safe for patients , who can and who can't donate blood etc. On the
occasion of World blood donors day , National blood transfusion service day and other
functions blood donors are recognized with different categories token loves and
certificates .

Application of Standard Operating Procedures (SOPs) in blood collection , testing , processing and supplying
The availability and safety of blood depends on multiple steps in the transfusion chain. This starts with a healthy and motivated population, recruitment and retention of VNRBD, processing and testing of all donated blood availability of blood and blood products rational use of blood and blood products and post transfusion monitoring of the patient. At every step, any lowering of quality would reflect adversely on the final product. The performance of any procedure will follow quality results only if standard operating procedures are followed.

Quality Control and Assurance
NRCS CBTS is participating in external quality assurance scheme of Australia and Bangkok It is felt that it should develop National Quality Control System and nationally coordinate through CBTS cooperation with Regional Centers in collaboration with NPHL.

Management, Supervision, Monitoring and Evaluation
It is a continuous process if it is to lead to steady improvement. The quality management system addresses each activity of the blood program defining, controlling and documentary every aspect of an operation. Therefore system improvement of technical aspect regarding quality of staff and quality management. Some selected regional centers should be upgraded and with its identification will be upgraded as referral center for neighboring district centers. Therefore, a systematic regular supervision and monitoring program will be developed.